Dr. Jeff Hersh: Is a stent a good option for BHP?

Tuesday

Oct 8, 2013 at 4:33 PMOct 8, 2013 at 4:33 PM

By Dr. Jeff Hersh

Q: I am 72, so would a urethral stent be a good treatment option for my BPH? I would rather avoid surgery if possible.

A: The prostate is the male organ that makes the fluid in semen. The urethra, the tube that carries urine from the bladder out of the body, passes through the prostate. The prostate gland continues to grow throughout a man’s lifetime, and it can enlarge enough to squish the urethra, impeding urine flow. The term for a non-cancerous enlarged prostate is benign prostatic hypertrophy (BPH).

Early BPH symptoms can include difficulty initiating urination, a weak stream, difficulty continuing the stream and/or dribbling at the end of urination. Higher levels of blockage can lead to more severe symptoms, possibly including the inability to pass any urine at all. Symptoms from BPH are extremely rare before age 40, but by age 55 about one in four men have some symptoms, and by age 75 over half of all men have symptoms.

BPH treatment is determined by the severity of symptoms. Minor symptoms, which are not significantly impacting the patient’s life, are usually treated with a “watch and wait” approach. Many men with minor symptoms do not develop more severe symptoms or actually have their symptoms improve, and no other treatment is required.

However, men with symptoms that are impacting the quality of their life, or whose minor symptoms progress, may require treatment with medications. Patients whose symptoms do not respond to medications or who have severe complications such as kidney damage, large ongoing blood in their urine, episodes of complete blockage (emergently treated with placement of a catheter through the urethra to allow urine drainage) or bladder stones, may require other interventions:

- Transurethral resection of the prostate (TURP), where prostate tissue is cut away using a specialized instrument inserted through the urethra, is the most common surgery for BPH and the treatment that other treatments are compared to. Procedure improvements have minimized side effects, but bleeding, surgical complications, urine incontinence or other complications still occur in a small percentage of patients.

- Transurethral incision of the prostate is an option for some men if their prostate is small enough and a TURP is not optimal.

- Open surgical resection may be required for some men with extremely large prostates, or those with complications such as bladder issues.

- Some patients may be candidates for less invasive procedures such as laser, microwave or electrical ablations to vaporize/burn away some of the prostate tissue.

- Stent placement (self-expandable metallic devices which apply a gentle outward force to push the urethra open to keep it patent) may be an option for selected patients; however the long-term experience with these devices is limited. Some studies have shown that men with urethral stents may develop bladder stones, or may develop granulation tissue around the stent leading to recurrence of their obstruction. Therefore, these devices are usually used only as a temporary treatment (rather than leaving a catheter in) for up to a month to bide time until a more definitive treatment can be performed.

Men with minor symptoms from heir BPH should modify their lifestyle by minimizing fluids before bedtime (to prevent the need to get up to urinate during the night), minimize fluids that increase urine production (such as alcohol or caffeine), work with their doctor to limit certain medications (such as diuretics for hypertension), not rush or strain when urinating, and may try herbal treatments such as saw palmetto or beta-sitosterol extracts (discuss this with your healthcare provider before taking medication, even herbal medications). However, the many men require more aggressive treatments should discuss the pluses and minuses with their urologist to select the best option for them.